Advances and highlights in allergic rhinitis

Real-world efficacy of sublingual immunotherapy with Japanese cedar pollen for cypress pollinosis

Background

It remains unclear whether allergen immunotherapy with Japanese cedar pollen extract is effective for Japanese cypress pollinosis in real-world settings.

Objective

We sought to investigate the Japan-wide prevalence of cypress pollinosis, the efficacy of cedar sublingual immunotherapy (SLIT) on cypress pollinosis, the role of serum-specific IgE levels in pollinosis, and patients' interest in the development of cypress SLIT.

Methods

A cross-sectional, multicenter study using self-administered questionnaires was conducted in regions of Japan where cedar and cypress pollen dispersals are prevalent. This study included patients aged 5 to 69 years who received cedar SLIT in 2023.

Results

Of 2597 participants analyzed, 84.5% experienced pollinosis symptoms during the cypress season before receiving cedar SLIT. Among these patients, 40.2% felt that cedar SLIT was less effective during the cypress season than during the cedar season. The longer the patients received cedar SLIT, the greater the inefficacy perceived during the cypress versus the cedar season. In the symptomatic patients, serum IgE levels were significantly higher for cedar and cypress as compared with those observed in subjects without symptoms during the cypress season. No significant differences were reported in IgE levels for cedar and cypress between patients reporting either high or lower efficacy for the cedar SLIT during cypress season. Interest in cypress SLIT was seen in 78.4% of these patients.

Conclusions

Although there is a bias based on regional distribution, cedar SLIT has induced a limited efficacy on cypress pollinosis in real-world settings, suggesting a need for the development of cypress SLIT.

Indolepropionic acid modulates the immune response in allergic rhinitis through the AKT/CEBPB/IL‑10 signaling pathway

Allergic rhinitis (AR) is a common inflammatory disorder of the nasal mucosa, usually triggered by environmental allergens. Indolepropionic acid (IPA) can influence immune responses; however, the specific mechanisms underlying the effects of IPA on immune regulation in AR remain largely unexplored. In the present study, an experimental mouse model of AR was established by sensitizing and exposing the mice to allergens, followed by the administration of IPA via gavage. Nasal symptoms were assessed through behavioral scoring, histological examinations were conducted to evaluate changes in nasal mucosa, and cytokine levels were quantified using ELISA. The expression of key signaling molecules was analyzed by immunohistochemistry, reverse transcription‑quantitative PCR and western blotting. Additionally, the effects of IPA combined with an AKT inhibitor (HY‑10355) on signaling pathway‑related proteins in human nasal epithelial cells were evaluated using cellular immunofluorescence and western blotting. The results revealed that IPA treatment significantly reduced nasal inflammation, as indicated by decreased sneezing and mucus secretion. Histological analysis showed reduced inflammatory cell infiltration and epithelial damage in IPA‑treated mice compared to controls. Furthermore, cytokine analysis revealed reduced levels of the pro‑inflammatory cytokines IL‑4, IL‑5, IL‑13 and immunoglobulin E, along with increased levels of the anti‑inflammatory cytokine IL‑10. Molecular investigations demonstrated that IPA can activate the AKT/CCAAT enhancer binding protein β pathway, leading to increased IL‑10 expression and reduced inflammation. In conclusion, these findings suggested that IPA may serve as a promising therapeutic strategy for managing AR, pending further clinical validation.

GBP2 Regulates Lipid Metabolism by Inhibiting the HIF-1 Pathway to Alleviate the Progression of Allergic Rhinitis

Allergic rhinitis (AR) is a prevalent allergic disorder instigated by a variety of allergenic stimuli. The study aims to elucidate the mechanistic underpinnings of Guanylate-binding protein 2 (GBP2) in modulating AR. Bioinformatics analysis was used to identify hub genes in AR, and GBP2 was identified. Mice were injected with ovalbumin (OVA) to create AR model. The pathological changes of the nasal mucosa were observed by hematoxylin-eosin staining. ELISA and western blot demonstrated that in OVA-induced AR mice, high IgE and IgG1 levels, inflammation (increased TNF-α, IL-5 and IFN-γ), oxidative stress (high ROS, low TAOC and GSH) and abnormal lipid metabolism (increased TC and LDL-C, decreased HLD-C) were observed. Mouse nasal mucosal epithelial cells (MNECs) were treated with TNF-α to simulate AR. Cell viability and apoptosis were evaluated by CCK-8 assay and flow cytometer, respectively. In vitro assay revealed that GBP2 inhibited total IgE, OVA-IgE and IgG1 levels and suppressed abnormal lipid metabolism, inflammation and oxidative stress to alleviate AR. Furthermore, HIF-1 pathway was screened as the downstream pathway of GBP2. GBP2 inhibited the HIF-1 pathway, and Fenbendazole-d3, the activator of HIF-1 pathway, weakened the inhibitory effects of GBP2 on apoptosis, inflammation, oxidative stress and abnormal lipid metabolism in vitro. In summary, GBP2 alleviated abnormal lipid metabolism, inflammation and oxidative stress by inhibiting the HIF-1 pathway, providing a direction for the treatment of AR.

Univariate versus multivariate approaches for resolving the overlapped spectra of azelastine hydrochloride and mometasone furoate

Azelastine hydrochloride (AZE) and Mometasone furoate (MOM) combination is used to treat allergic rhinitis' symptoms. The aim of this work is to qualitatively and quantitatively analyze both medications using univariate and multivariate spectrophotometric techniques in a comparative study. Regarding univariate approaches; AZE was quantified by direct measurement at 291 nm within (5-60 μg/mL) concentration range. While, MOM was assayed by absorption correction (AC) approach at 250 nm within the range of (2-18 μg/mL). The LOD values for AZE and MOM were (0.79 μg/mL) and (0.21 μg/mL), respectively. Classical least squares (CLS), partial least squares (PLS), principal component regression (PCR), multivariate curve resolution-alternating least squares (MCR-ALS) and artificial neural networks (ANN) were the applied multivariate chemometric models. The proposed methods were utilized for analyzing the binary mixture in laboratory-synthetic mixtures and pharmaceutical preparation with correlation coefficients values ≥ 0.9996. No statistically significant variation was found between the applied methods and the reported HPLC one. The methods' sustainability was assessed using blue applicability grade index (BAGI) and Red-Green-Blue 12 (RGB12) metrics. The obtained findings revealed that the suggested methodologies are safer option than the published HPLC technique for the conventional pharmaceutical analysis of the studied medications.

MiR-155 overexpression regulates Th1/Th2 balance by inhibiting BACH1 to activate Nrf-2/HO-1 signaling pathway in allergic rhinitis

Allergic rhinitis (AR) is a common respiratory inflammatory disease characterized by Th2 inflammatory response from exposure to allergens. The current study aimed to explore the underlying mechanism of miR-155 in AR. Nasal mucosa tissue samples and nasal lavage fluid samples were obtained from patients diagnosed with AR and healthy subjects who served as the control. We found that the miR-155 expression was downregulated in AR patients while the expression of BACH1 was upregulated. miR-155 overexpression reduced apoptosis, the levels of IL-4 and IL-12 in AR nasal epithelial cells (NECs). CD4+T cells were treated with supernatant of NECs following miR-155 overexpression. miR-155 up-regulation elevated the ratio of Th1/Th2, reduced the levels of IL-4 and IL-5, elevated the levels of IFN-γ and IL-12 in CD4+T cells. Down-regulation of SOCS1 and SOCS3, up-regulation of SOCS4, SOCS5 and SOCS6 were observed in CD4+T cells following treatment of NECs with miR-155 overexpression. Mechanically speaking, miR-155 activated Nrf2/HO-1 signaling pathway by interacting with BACH1. miR-155 elevated Th1/Th2 proportion in CD4+T cells by activating Nrf2/HO-1 signaling pathway. Moreover, an AR mouse model was also constructed, the frequency of sneezing, nose rubbing, and rhinorrhea were elevated. After treatment with miR-155 agomir, these symptoms were significantly alleviated. In conclusion, this work showed that miR-155 activated Nrf2/HO-1 signaling pathway by targeting BACH1, thereby affecting Th1/Th2 balance in AR. Our findings suggest that miR-155 could hold promise as a novel AR therapy.

Synthesis, anti-allergic rhinitis evaluation and mechanism investigation of novel 1,2,4-triazole-enamides as CB1 R antagonist

Allergic rhinitis (AR) is a non-infectious inflammatory disease and affects nearly half of the world's population currently, thus becoming a global health problem. In our study, a series of 1,2,4-triazole enamides were designed and used to evaluate the anti-inflammatory activity of AR. We found that compound 11g could significantly reduce the increased expression of interleukin-6 (IL-6), interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in Raw264.7 cells induced by lipopolysaccharides (LPS), and inhibit the expression of inflammation through MAPK pathway and NF-κB pathway by influencing the expression of cannabinoid-1 receptor (CB1 R). In the AR mice model, 11g can significantly reduce the number of inflammatory cells in Nasal lavage fluids (NLF), showing a good effect on the treatment of AR. This study provides a new and effective candidate for treatment of AR.

Feasibility of MASK-air® use in allergic rhinitis patients receiving immunotherapy and the effect on quality of life

BACKGROUND

The aim of MASK-air® application is to enhance awareness of allergic rhinitis (AR) and its complications, thereby reducing the risk of developing asthma.

OBJECTIVE

The aims of this study were to evaluate the impact of MASK-air® on the quality of life (QoL) and symptomatology of AR patients undergoing allergen immunotherapy (AIT). The study also evaluated patient satisfaction with the application.

MATERIALS AND METHODS

A prospective cross-sectional study was conducted between August and November 2019 at a tertiary Allergy and Immunology center involving patients receiving AIT. Participants were instructed on accessing and utilizing MASK-air® daily through face-to-face interviews. Concurrently, the Score for Allergic Rhinitis (SFAR) and the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) were administered alongside MASK-air® Visual Analog Scale (VAS) scores. After 6 months, RQLQ scores were reassessed and a satisfaction survey was conducted.

RESULTS

This study comprised 96 patients. Significant correlations were observed among SFAR, RQLQ, and VAS scores. After 6 months of MASK-air® usage, improvements in QoL and symptom reduction were evident. Notably, participants who consistently used MASK-air® demonstrated significant reductions in activity limitations and hay fever scores compared to irregular users (p = 0.05 and p = 0.02, respectively). Additionally, participants under 40 years of age and those with higher education levels exhibited a greater inclination toward online monitoring via the application. Overall, participants found MASK-air® practical, citing various advantages and disadvantages.

CONCLUSION

MASK-air® serves as a valuable tool for physicians in managing treatment and is associated with validated, reliable scales. Its use was linked to enhanced QoL and symptom reduction among participants, irrespective of treatment duration.

Association Between Diabetes Mellitus and Allergic Diseases Sensitized by Different Allergens and the Potential Mechanism of Diabetes Mellitus Affecting Ovalbumin-Induced Allergic Rhinitis

ObjectiveTo investigate the association between diabetes mellitus (DM) and allergic diseases caused by different allergens and explore the mechanism of DM in allergic rhinitis (AR) induced by ovalbumin (OVA).MethodsWe established linear regression models to examine the correlation of specific immunoglobulin E (sIgE) and total immunoglobulin E (TIgE) with glycohemoglobin (A1c) and fasting plasma glucose (FPG) in individuals allergic to different allergens by retrospectively analyzing the 2005-2006 National Health and Nutrition Examination Survey database. Participants were classified into Allergy + DM and Allergy groups based on whether they had allergic disease and DM or only allergic disease. An AR mouse model was established using OVA. Mice were randomly assigned to the control, AR, diabetic (db), or db & AR group, with 6 mice in each group. The expression of GATA3, T-bet, and Foxp3 was detected using immunofluorescence and western blotting. Cytokines, FPG, A1c, and immunoglobulin in serum were detected using enzyme-linked immunosorbent assays.ResultsBased on the database, the TIgE and SIgE levels in participants with perennial allergies were lower in the Allergy + DM group than in the Allergy group, whereas those in participants with food allergies were higher in the Allergy + DM group than in the Allergy group. TIgE was negatively correlated with FPG or A1c in participants with perennial allergies and positively correlated with FPG and A1c in participants with egg allergy (among food allergens). In mice, AR symptoms, eosinophilic infiltration, and OVA-induced IgE levels were more serious in the db & AR group than in the AR group. TIgE was positively correlated with FPG, and interleukin-2 (IL-2) was negatively correlated with FPG; this was most pronounced in db & AR mice. The expression of T-bet and Foxp3 in mice was negatively associated with A1c.ConclusionsThe effect of DM on allergic diseases is related to the type of allergen. Decreased IL-2, T-bet, and Foxp3 levels resulting from elevated FPG and A1c levels may be involved in the association between OVA-induced AR and DM.

Sensitization of common allergens and co-sensitization patterns in the Korean population

Allergic diseases occur frequently and reduce the quality of life in patients with allergies. Many studies have investigated the pattern of various allergic antigens; however, studies on general patients are insufficient. Sensitization of allergens varies greatly depending on race or region. This study aims to investigate the sensitization of common allergens present in Korea and co-sensitization patterns among these allergens. We used data obtained from the Korea National Health and Nutrition Examination Survey conducted in 2019. Serum-specific immunoglobulin E levels were measured using the ImmunoCAP assay for Dermatophagoides farinae (Df), dog, cat, birch, oak, Japanese hop (J-hop), and ragweed. In addition, demographic data and responses to a questionnaire about rhinitis symptoms were obtained. The ImmunoCAP assay was performed on 2,397 out of 8,110 participants. The sensitization rate to at least one antigen was 45.2%. Df was the most common sensitized allergen (39.9%), followed by oak (11.2%), birch (10.2%), ragweed (8.7%), and cat (8.5%). Among the sensitized participants, 41.3% were sensitized to multiple antigens. In participants sensitized to a single allergen, 91.8% were sensitized to Df. In individuals sensitized to seasonal allergens, approximately 75% showed sensitization to Df too (birch: 74.6%, oak: 74.3%, J-hop: 74.3%, and ragweed: 76.3%). Around 90% exhibited co-sensitization with Df among individuals sensitized to perennial antigens (dog: 91.6% and cat: 88.7%). The allergen sensitization rate in the general population was about 41.3%. In addition, Df was co-sensitized to 75% of participants sensitized to seasonal allergens and 90% of participants sensitized to perennial allergens. Most allergens showed a tendency for sensitization to decrease with age, while some allergens exhibited peak sensitization at different age ranges. Further research is needed to explore these differences and their associations with co-sensitization. Moreover, studies are required to investigate how these cross-reactivity patterns are associated with patients' symptoms.

The Clinical Efficacy and Safety of Endoscopic Vidian-Branch Neurectomy in Intractable Allergic Rhinitis

OBJECTIVE

Intractable allergic rhinitis (iAR) remains a clinical challenge. This study aims to evaluate the efficacy and safety of endoscopic selective vidian branch neurectomy for iAR.

STUDY DESIGN

A prospective clinical study.

SETTING

A tertiary referral center.

METHODS

A total of 205 iAR patients were initially recruited and divided into 3 groups: endoscopic vidian-branch neurectomy (EVBN), endoscopic vidian neurectomy (EVN), and conservative treatment (control). All patients were followed up for more than 2 years, and the efficacy and postoperative complications were compared.

RESULTS

After 2-year follow-up, a total of 195 patients were included, with 59 patients in EVBN group, 71 in EVN group, and 64 in control group. Post-treatment assessments at 6 months, 1 year, and 2 years revealed significant reductions in the total Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores and each domain in both EVBN and EVN groups compared to their baseline levels. However, no significant changes were observed in control group. Furthermore, the improvements in RQLQ 2 years post-treatment were higher in EVBN and EVN groups compared to control group. In EVBN group, only 3 (5.1%) patients reported mild eye dryness during the first month postoperation. However, in the EVN group, 15 (21.1%) patients experienced eye dryness, with 6 (8.5%) cases persisting for more than 1 year and remaining unresolved by the end of the 2-year follow-up.

CONCLUSION

Both EVBN and EVN were effective in iAR patients. However, EVBN appears to be a safer option, associated with fewer postoperative complications.

Prediction of outpatient visits for allergic rhinitis using an artificial intelligence LSTM model - a study in Eastern China

BACKGROUND

Allergic rhinitis is a common disease that can affect the health of patients and bring huge social and economic burdens. In this study, we developed a model to predict the incidence rate of allergic rhinitis so as to provide accurate information for the treatment, prevention, and control of allergic rhinitis.

METHODS

We developed a Long Short-Term Memory model for effectively predicting the daily outpatient visits of allergic rhinitis patients based on air pollution and meteorological data. We collected the outpatient data from the departments of otolaryngology, emergency medicine, pediatrics, and respiratory medicine at the Affiliated Hospital of Hangzhou Normal University, from January 2022 to August 2024. The data were stratified by gender and age and were separately input into the model for evaluation. A total of 25,425 outpatient data samples were assessed in this study.

RESULTS

Based on the data obtained from males (n = 13,943), females (n = 11,482), adults (n = 17,473), and minors (n = 7,952), the normalized mean squared errors of the Long Short-Term Memory model were 0.4674976, 0.3812502, 0.418301, and 0.4322124, respectively. By comparing the NMSE prediction results of ARIMA and LSTM models on this dataset, the LSTM model was found to outperform the ARIMA model in terms of stability and accuracy.

CONCLUSIONS

The model presented here could effectively predict the daily outpatient visits for allergic rhinitis patients based on air pollution and meteorological data, thereby offering valuable data-driven support for hospital management and for potentially improving societal management and prevention of allergic rhinitis.

How Climate Change Is Impacting Allergic Rhinitis: A Scoping Review

OBJECTIVE

The impact of climate change on health has become an increasingly widespread global health concern. This impact is especially relevant in the field of Otolaryngology; global warming has been shown to affect inflammatory upper airway disease, specifically allergic rhinitis (AR). This study aims to characterize the effect of climate change on the epidemiology of AR in adult and pediatric populations globally.

DATA SOURCES

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was performed across four databases. Inclusion criteria were: (1) published in English, (2) published between 2000 and 2023, (3) reported on the current epidemiological state of AR, (4) described factors related to climate change, and (5) observed global warming affecting allergy season and AR symptoms.

REVIEW METHODS

Two reviewers screened articles and performed full-text reviews.

RESULTS

Of the 502 articles assessed, 30 studies were eligible for inclusion. Sixteen studies reported longer pollen seasons and/or higher pollen concentrations related to climate change, with two projecting total pollen emissions to increase by 16-40% and pollen season length to increase by 19 days in North America. Four studies reported an increase in AR-related healthcare usage; low-income residents were most impacted by increased usage. Two studies identified that healthcare professionals want more education on climate change.

CONCLUSION

Our scoping review highlights how climate change is altering pollen seasons and concentrations, AR disease prevalence, allergy sensitization, and AR symptom severity. Health professionals have expressed an understanding of climate change's impact on health and a desire for further education.

LEVEL OF EVIDENCE

N/A.

Identification of Active Markers of Chinese Formula Yupingfeng San by Network Pharmacology and HPLC-Q-TOF-MS/MS Analysis in Experimental Allergic Rhinitis Models of Mice and Isolated Basophilic Leukemia Cell Line RBL-2H3

Background: Yupingfeng San (YPFS) is a classic formula for treating allergic rhinitis (AR), which is composed of Astragalus mongholicus Bunge (AST), Atractylodes macrocephala Koidz (AMR), and Saposhni-kovia divaricata (Turcz.) Schischk (SR) at a ratio of 3:1:1. However, the potential bioactive components of YPFS relevant to AR treatment are currently unknown. Methods: This study combined in vivo chemical profiling, network pharmacology, and experimental validation to identify the substances in YPFS that are active against AR. Results: Firstly, 98 compounds in YPFS were identified using high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (HPLC-Q-TOF-MS/MS) with the assistance of Global Natural Products Social (GNPS) molecular networking. Then, 42 prototype components and 57 metabolites were detected in the plasma, urine, and feces of mice with AR. A network pharmacological analysis based on 42 in vivo prototypical components was also conducted to screen 15 key components and 10 core targets, and 6 key components were further selected through molecular docking. Finally, the four key active components (cimifugin, wogonin, formononetin, and atractylenolide I) were revealed to be the main ingredients of YPFS through validation (in vitro and in vivo). Conclusions: This is the first systematic study of the components of YPFS in AR mice, laying the foundation for elucidating the overall material basis of this formulation. This study provides rich basic data for further pharmacological and mechanistic studies on YPFS.

Metformin attenuated depressive-like behaviors by suppressing TRPV1/NLRP3 mediated neuroinflammation in the hypothalamus of allergic rhinitis mice

In addition to nasal symptoms, allergic rhinitis (AR) has increasingly been reported to be associated with depression-like behaviors. Recent evidence suggests that neuroinflammation in the hypothalamus may cause these depressive symptoms in AR. However, the precise mechanisms and effective treatments remain to be elucidated. This study investigated the ameliorative effects of metformin on neuroinflammation in the hypothalamus, depressive-like behavior and the underlying molecular mechanisms of AR mice. Mice were administered ovalbumin (OVA) intranasally to induce allergic rhinitis and subsequently subjected to behavioral experiments to detect depressive-like behavior. The roles of the TRPV1/NLRP3 pathway in depression-like behaviors in AR were examined in vivo. Additionally, the mechanism of TRPV1/NLRP3-mediated neuroinflammation was investigated in vitro. Finally, metformin was utilized to explore its possible mechanisms and efficacy in treating depressive-like behavior in AR. AR mice exhibited significant depressive-like behavior, which was attenuated by metformin. The number of Iba-1+ microglia significantly increased in the hypothalamus of AR mice. The expression of NLRP3 was significantly upregulated in the hypothalamus, activating microglia. Metformin ameliorated the neuropsychiatric symptoms by reducing NLRP3 expression in the hypothalamus. Moreover, metformin inhibited LPS-induced upregulation of the TRPV1/NLRP3 signaling pathway in microglial cell line, an effect that can be reversed by the TRPV1-specific agonist capsaicin. Increased TRPV1 expression activates the NLRP3 inflammasome in hypothalamic microglia, promoting the pathological process of depressive-like behavior in AR mice. Metformin could effectively treat neuroinflammation by regulating microglia via TRPV1 downregulation, indicating its potential as a treatment for depressive-like behaviors in AR.

Metabolic Biomarkers Mediate Allergic Conjunctivitis via Circulating Inflammatory Proteins: Evidence From a Mendelian Randomization Study

Purpose

This study aimed to investigate the mediating role of metabolic biomarkers (MBs) in the association between circulating inflammatory proteins (CIPs) and allergic conjunctivitis (AC) and identify potential therapeutic targets.

Methods

A Mendelian randomization (MR) study was conducted, leveraging genetic variants as instrumental variables to infer causal relationships. Data were obtained from genome-wide association studies (GWASs), and a two-sample MR was employed to estimate the direct and indirect effects of CIPs on AC through MBs. Inverse-variance weighting (IVW) served as the primary analysis method, supplemented by sensitivity analyses to assess the robustness of findings.

Results

Six CIPs were found to have significant causal effects on AC. Natural killer cell receptor 2B4 (CD244) exhibited a protective effect, and interleukin-18 receptor 1 (IL-18R1), IL-6, leukemia inhibitory factor (LIF), protein S100-A12 (EN-RAGE), and TNF-related activation-induced cytokine (TRANCE) were identified as risk factors. The MR analysis indicated the mediation role of specific MBs in these associations, with MBs such as 4-oxo-retinoic acid, gulonate, 3-(4-hydroxyphenyl) lactate, S-adenosylhomocysteine, and sphingomyelin, significantly influencing the pathway from CIPs to AC.

Conclusions

This study highlights the crucial role of MBs in mediating the association between CIPs and AC. These findings offer new insights into the pathophysiology of AC and suggest potential metabolic targets for novel therapeutic approaches.

Translational Relevance

This study underscores the potential for targeting specific MBs as novel therapeutic approaches to modulate the inflammatory pathways implicated in AC.

Abnormal purine metabolism in nasal epithelial cells affects allergic rhinitis by regulating Th17/Treg cells

We aimed to explore novel pathogenesis in young children with allergic rhinitis (AR), and thus finding novel nasal spray reagents for them, especially under 4 yr old. In this study, nontargeted metabolomics analyses were used to explore the differential metabolites in nasal lavage fluid (NALF) of children with AR. Cell Counting Kit-8 (CCK-8) and flow cytometry were used to assess cell proliferation and apoptosis in human nasal mucosal epithelial cells (HNEpCs). HNEpCs were cocultured with CD4+ T cells, and flow cytometry was used to detect Th17/regulatory T (Treg) cells. RNA sequencing was used to assess the key pathways in xanthine-treated Jurkat T cells. Finally, both the in vitro and in vivo experiments were used to assess the effect of 1, 3-dipropyl-8 cyclopentylxanthine (DPCPX, Adora1 inhibitor) on activating transcription factor 4 (ATF4) expression and Th17/Treg cells. Xanthine and uric acid levels were increased in the NALF of children with AR. Xanthine dehydrogenase (XDH), purine nucleoside phosphatase (PNP), xanthine/hypoxanthine, and uric acid levels were elevated in Derp1-treated HNEpCs, and si-XDH reversed the reduced cell viability and increased cell apoptosis in Derp1-treated HNEpCs. Both xanthine and Derp1-treated HNEpCs increased the Th17/Treg ratio. The endoplasmic reticulum stress (ERS) pathway was affected in xanthine-treated Jurkat T cells, and ATF4 was markedly reduced in xanthine-treated Jurkat T cells. Xanthine exhibited no effect on Adora1 expression, whereas DPCPX elevated ATF4 expression and reduced the Th17/Treg ratio in xanthine-treated Jurkat T cells. The in vitro experiments revealed that DPCPX reduced inflammatory infiltration, Th17/Treg ratio, interleukin (IL)-17, tumor necrosis factor (TNF)-α, and IL-6 in AR mice. These results demonstrated that xanthine inhibited ATF4 expression via Adora1 to elevate the Th17/Treg ratio in the nasal cavity, thus participating in AR progression. These findings may provide novel therapeutic interventions for young children with AR.NEW & NOTEWORTHY Current nasal spray hormones exhibited some adverse reactions for young children with allergic rhinitis (AR), and there were no suitable nasal spray hormones for children with AR under 4 yr old. This study emphasized the important role of purine metabolism in the nasal cavity in children with AR and provided novel therapeutic interventions for children with AR.

Risk factors for postpartum depression in pregnant women with allergic rhinitis: a retrospective study

OBJECTIVE

Allergic rhinitis can cause symptoms to worsen after pregnancy and may cause problems such as postpartum depression. The goal of this study was to investigate the factors that influence postpartum depression in pregnant women with allergic rhinitis (AR).

METHODS

We conducted a retrospective cohort study that included women with AR (based on self-reports) between June 2015 to June 2019 in Harvard University Partners Healthcare Systems (PARTNERS) in the USA. The study group was divided into postpartum depression and non-postpartum depression. Routine clinical and laboratory information was collected. Univariate and least absolute shrinkage and selection operator (LASSO, employed for predictor selection) regression analysis was used to study associations between AR during pollen seasons and adverse outcomes. Additionally, the receiver operating characteristic (ROC) curve evaluates discriminative ability by the area under the ROC curve (AUC). The calibration curve (DCA) was conducted to determine the clinical utility and benefit of the nomogram.

RESULTS

A total of 216 pregnant women with AR participated in this study. Univariate analysis showed that 7 indicators were significantly different (P < 0.05). LASSO and multivariable regression identified four predictors to construct a nomogram for PPD in pregnant women with AR, the four selected risk predictors are as follows: pollen season pregnancy (OR = 1.514, 95%CI: 0.771-2.973), history of preterm birth (OR = 2.723, 95%CI: 1.157-6.406), number of pregnancies (OR = 2.104, 95%CI: 1.356-3.267), anti-allergy medication during pregnancy (OR = 2.975, 95%CI: 1.521-5.819). The nomogram displayed good discrimination, with AUC of 0.732 (95% CI: 0.657-0.808). The risk of postpartum depression increased with the increasing risk score of predictive nomogram. The calibration curve and DCA present optimal predictive power.

CONCLUSIONS

We highlighted the comorbidity of AR and postpartum depression, and suggested that a multidisciplinary consideration between allergists and obstetricians or midwives is needed to ensure that pregnant women consult experts to reduce AR symptoms.

TRIAL REGISTRATION NUMBER

2018P002646.

Association between alcohol consumption and allergic rhinitis in US adults

Introduction

Increasing evidence suggests that alcohol consumption may be associated with allergic diseases. This cross-sectional analysis aimed to determine the correlation between alcohol consumption patterns and allergic rhinitis (AR) in US adults.

Methods

A cross-sectional study was conducted involving 2,179 individuals aged 20 years and older who took part in the 2005-2006 National Health and Nutrition Examination Survey (NHANES), which assessed AR and alcohol consumption patterns. Alcohol consumption was categorized into three groups: "Never" (fewer than 12 drinks in a lifetime), "Now" (currently drinking), and "Former" (a prior history of drinking but no longer consuming alcohol). The association between alcohol consumption patterns and AR was analyzed separately for men and women, adjusting for several comorbidities.

Results

Individuals who currently consume alcohol are more likely to exhibit elevated levels of total IgE and cat/dog dander-specific IgE compared to non-consumers. Compared to "Never" in the male group, "Now" (currently drinking) was positively associated with AR in both the partially adjusted analysis and the fully adjusted model. However, we did not find any positive relationship between alcohol consumption patterns and AR in the female group, which suggests that current drinking was linked to a higher prevalence of AR in men but not in women.

Conclusion

We discovered that current drinking was positively associated with a high prevalence of AR in men.

Correlation between monocyte and length of in-hospital stay in patients with allergic rhinitis: data from the MIMIC-IV database

BACKGROUND

This study aimed to explore the factors associated with the length of in-hospital stay (LOS) in allergic rhinitis (AR).

METHODS

Patients with AR and related data were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The influencing factors of LOS were determined by correlation analysis and linear regression. We ranked the importance of significant variables. Finally, mediation analysis was performed to explore the potential mediating factors associated with LOS.

RESULTS

This retrospective study enrolled 937 patients diagnosed with AR. Correlation analysis showed that 10 variables were closely correlated with the LOS. Linear regression further showed that albumin, white blood cell (WBC), red blood cell (RBC), red cell distribution width (RDW), total Ca, and monocyte were independently related to the LOS (all P < 0.05). After considering comorbidities, monocyte, albumin, WBC, RBC, total Ca, and Charlson comorbidity index were independent factors for LOS (all P < 0.05). The permutation importance exhibited that monocyte was the most important variable. Finally, mediation analysis demonstrated that WBC played a mediating role in the relationship between monocytes and LOS.

CONCLUSION

Monocyte level is related to the LOS of patients with AR, and their relationship can be mediated by WBC. Medical and nursing staff can stratify AR management according to monocyte levels to make crucial clinical decisions and shorten LOS.

CLINICAL TRIAL

Not applicable.

Investigation of the diagnostic accuracy of basophil activation test for allergic phenotypes of rhinitis

INTRODUCTION

Basophil activation test (BAT) might be an alternative to nasal allergen challenge (NAC) to identify the allergic etiology in rhinitis patients. Here, we investigate the diagnostic performance of BAT for allergic phenotypes of rhinitis.

METHODS

Rhinitis patients and healthy controls were subjected to NAC with Dermatophagoides pteronyssinus (DP), Alternaria alternata (AA), grass (GP) and olive (OP) pollens. Rhinitis subjects also underwent skin prick test (SPT) with relevant allergens. Patients were classified into allergic rhinitis (AR, positive NAC and SPT), local allergic rhinitis (LAR, positive NAC and negative SPT), dual allergic rhinitis (DAR, defined as AR for ≥1 allergen and LAR for ≥1 allergen), and non-allergic rhinitis (NAR, negative NAC and SPT) phenotypes. BAT with DP, AA, GP and OP was conducted in study individuals and compared with NAC results.

RESULTS

A total of 47 AR, 31 DAR, 26 LAR, 12 NAR and 21 control subjects were recruited. The best positivity cut-offs of BAT for DP-, AA-, GP- and OP-driven allergy (all phenotypes) were a %CD63 cells of 8.650, 14.250, 26.200, and 12.780, respectively (AUC 0.851, 0.701, 0.887, and 0.921, respectively). Sensitivity, specificity, negative and positive predictive values of BAT (all phenotypes) ranged 43.5%(AA)-83.3%(OP), 88.9%(GP)-100%(AA), 87%(GP)-100%(AA), and 61.1%(DP)-80.0%(pollens), respectively. BAT identified 79%-100% of SPT-positive allergies (AR and DAR), and 25%-75% of SPT-negative allergies (LAR and DAR), while ≤10% of NAR/HC subjects tested positive. BAT positivity correlated with rhinitis severity in LAR patients (p = 0.018), and associated with conjunctivitis (p = 0.015) in allergic subjects.

CONCLUSION

BAT can replace NAC for AR confirmation, and limit the number of NAC required for LAR and DAR diagnosis. BAT can demonstrate sIgE in SPT-negative allergies.

The Bidirectional and Temporal Associations of Depression With Allergic Rhinitis and Chronic Rhinosinusitis: A Nationwide Cross-Sectional Study

PURPOSE

This study aimed to delve into the bidirectional and temporal relationship between depression, allergic rhinitis (AR) and chronic rhinosinusitis (CRS).

METHODS

A total of 17,028 participants from the Korean National Health and Nutritional Examination Survey, surveyed in 2016, 2018, and 2020, were included in this study. Participants' medical histories were used to determine their depression, AR and CRS status, as well as the age at diagnosis. Logistic regression analyses were conducted to reveal the associations between AR/CRS and depression. Subgroup analysis was performed considering various clinical characteristics.

RESULTS

Regardless of occurring independently or coexisting, AR and CRS consistently preceded the diagnosis of depression. The prevalence of depression was higher among patients with AR and CRS, and similarly, the prevalence of AR and CRS was elevated among patients with depression (all P < 0.001). Depression was associated with increased odds of AR (odds ratio [OR], 1.646; 95% confidence interval [CI], 1.309-2.071; P < 0.001) and CRS (OR, 1.882; 95% CI, 1.427-2.416; P < 0.001). Similarly, AR (OR, 1.613; 95% CI, 1.278-2.036; P < 0.001) and CRS (OR, 1.869; 95% CI, 1.415-2.467; P < 0.001) were both associated with heightened odds of depression.

CONCLUSIONS

The study findings indicated a bidirectional and complex association between depression and AR/CRS, emphasizing the importance of early detection and intervention.

Associations of leisure-time and occupational physical activity with allergic rhinitis and chronic sinusitis in middle-aged adults: a population-based study

OBJECTIVE

To explore the links of leisure-time physical activity (LTPA), and occupational physical activity (OPA) with allergic rhinitis (AR) and chronic rhinosinusitis (CRS) in a nationally representative sample of the Korean population.

METHODS

10,346 participants aged 40-60 years old were obtained from the KNHANES 2014-2018 database. Physical activity levels were assessed using questions adapted from the Korean version of the Global Physical Activity Questionnaire. Participants were categorized as having high or low LTPA or OPA. AR and CRS statuses were determined based on participants' medical histories. Univariate and multivariate logistic regression analyses were conducted to uncover the associations between AR/CRS and LTPA/OPA. Subgroup analysis was performed considering various clinical characteristics.

RESULTS

The multivariate regression analysis revealed high OPA as a risk factor for AR in middle-aged adults (odds ratio [OR] = 1.474, 95% confidence interval [CI]: 1.130, 1.924), especially among males (OR = 1.665, 95% CI: 1.147, 2.417), individuals with BMI ≥ 25 (OR = 1.717, 95% CI: 1.124, 2.623), blue-collar workers (OR = 1.686, 95% CI: 1.074, 2.642), and green-collar workers (OR = 4.178, 95% CI: 1.642, 11.319). However, no notable correlation was revealed between LTPA and AR prevalence (P > 0.5), nor between OPA or LTPA and CRS prevalence (P > 0.5).

CONCLUSIONS

LTPA and OPA exhibit different links with AR, suggesting that high levels of OPA in AR individuals should be addressed. However, neither LTPA nor OPA shows a significant correlation with CRS.

Prevalence of Allergic Rhinitis Among Children and Its Characteristics in Al-Qassim Region, Saudi Arabia

Objective The objective of the study is to estimate the prevalence of allergic rhinitis (AR) and its characteristics among the pediatric population at Dr. Suliman AlHabib Hospital in Buraydah, Al-Qassim region, Saudi Arabia. Methods This cross-sectional, retrospective study utilized data (n = 217) from the ENT department's medical records at Dr. Suliman AlHabib Hospital in Buraydah, covering a three-year period from January 1, 2020, to January 1, 2023. A modified version of the International Study of Asthma and Allergies in Children (ISAAC) questionnaire was employed. The data was analyzed using R language version 4.3.3 (R Foundation for Statistical Computing, Vienna, Austria). Results The prevalence of AR among the children studied was 7%, with male patients showing a higher prevalence than female patients. No significant correlation was found between AR prevalence and age or body mass index (BMI), although adolescents were noted to have the highest prevalence compared to other age groups. Family history of allergies and parental smoking emerged as potential influencing factors, suggesting that environmental and genetic components might play a role in the development of AR. Conclusion The study highlights key trends in the epidemiology of AR among children in Buraydah. Although several risk factors, such as family history and parental smoking, were identified, the findings suggest the need for further research to fully understand the underlying causes and influences on AR. Future studies should aim to expand the sample size and investigate these associations more comprehensively to support effective public health strategies in the region.

Pilot application of an inflammation and physiological dysregulation index based on noninvasive salivary biomarkers

BACKGROUND AND OBJECTIVE

Noninvasive salivary biomarkers can be used to assess the cumulative subclinical health impacts of social and environmental stressors. We evaluated seven salivary biomarkers of neuroendocrine and immune functions and a group index of physiological dysregulation based on these biomarkers in a pilot survey in a socioeconomically disadvantaged population.

RESULTS

Participants recruited at subsidized public housing projects in Denver, Colorado, completed a sociodemographic, behavioral, and health questionnaire and used passive drool samplers to collect five saliva samples over the course of 1 day. Samples were tested for the neuroendocrine biomarkers alpha-amylase, cortisol, and dehydroepiandrosterone (DHEA) as well as immune system/inflammation biomarkers C-reactive protein (CRP), interleukin (IL)-1β, IL-6 and total immunoglobulin A (IgA). A composite Inflammation and Physiological Dysregulation Index (IPDI) was calculated as a count of potentially unhealthy values of dichotomized biomarkers. In 20 individuals who completed the survey (average age 46 years, 75% females), allergy to house dust was significantly associated with increased IPDI (adjusted for age) and significantly increased odds of potentially unhealthy values of total IgA, IL-1β, and CRP. Age, obesity, diabetes, allergy to pollen, recent loss of employment, and depression, anxiety, and stress scores from the standard DASS-21 questionnaire were positively but not significantly (0.05 < p < 0.2) associated with IPDI. This project demonstrated an application of a composite index based on noninvasive salivary biomarkers to assess subclinical health impacts of chronic social stressors.

Exploring Advances in Natural Plant Molecules for Allergic Rhinitis Immunomodulation in Vivo and in Vitro

Allergic rhinitis (AR) is a prevalent allergic disease that imposes significant economic burdens and life pressures on individuals, families, and society, particularly in the context of accelerating globalization and increasing pathogenic factors. Current clinical therapies for AR include antihistamines, glucocorticoids administered via various routes, leukotriene receptor antagonists, immunotherapy, and several decongestants. These treatments have demonstrated efficacy in alleviating clinical symptoms and pathological states. However, with the growing awareness of AR and rising expectations for improvements in quality of life, these treatments have become associated with a higher incidence of side effects and an elevated risk of drug resistance. Furthermore, the development of AR is intricately associated with dysregulation of the immune system, yet the underlying pathogenetic mechanisms remain incompletely understood. In contrast, widely available natural plant molecules offer multiple targeting pathways that uniquely modify the typical pathophysiology of AR through immunomodulatory processes. This review presents a comprehensive analysis of both in vivo and in vitro studies on natural plant molecules that modulate immunity for treating AR. Additionally, we examine their specific mechanisms of action in animal models to provide new insights for developing safe and effective targeted therapies while guiding experimental and clinical applications against AR.

HMOX1 as a potential drug target for upper and lower airway diseases: insights from multi-omics analysis

BACKGROUND

Oxidative stress is key in inflammatory airway diseases. Heme oxygenase 1 (HMOX1) regulates oxidative stress, but its role in airway diseases needs exploration.

METHODS

Differentially expressed genes (DEGs) between healthy nasal mucosa and chronic rhinosinusitis with nasal polyps (CRSwNP) were identified from Gene Expression Omnibus (GEO). Candidate genes were further screened using Gene Set Enrichment Analysis (GSEA) and Random Forest (RF) algorithms. Causal inference between candidate genes and upper and lower airway diseases (CRSwNP, allergic rhinitis (AR), and asthma (AS)) was conducted using bidirectional two-sample Mendelian randomization (TwoSampleMR) analysis. Single-cell RNA sequencing (scRNA-seq) data were used to determine the cellular localization and intercellular interactions of candidate genes. Molecular docking was used to identify potential therapeutic agents.

RESULTS

HMOX1 expression was significantly elevated in CRSwNP. TwoSampleMR analysis indicated a negative causal relationship between HMOX1 exposure and the occurrence of upper and lower airway diseases (CRSwNP [(odds ratio (OR)/95% confidence interval (CI): 0.945/(0.893-0.999), P = 0.044], AR [OR/95% CI: 0.997/(0.994-0.999), P = 0.007], and AS [OR/95% CI: 0.935/(0.895-0.977), P = 0.003]). scRNA-seq data revealed HMOX1 localization in M2 macrophages. Molecular docking identified 15 antioxidants, including Acetylcysteine and Quercetin, that can upregulate HMOX1 expression.

CONCLUSION

HMOX1 may have a protective role in the pathogenesis of upper and lower airway diseases (CRSwNP, AR, and AS) by modulating oxidative stress. Antioxidants that increase HMOX1 expression could offer new therapeutic avenues for these diseases.

CLINICAL TRIAL

Not applicable.

Bidirectional association between allergic rhinitis and attention-deficit/hyperactivity disorder: A systematic review and meta-analysis

BACKGROUND

This meta-epidemiological study seeks to further investigate the reciprocal relationship between allergic rhinitis (AR) and attention-deficit/hyperactivity disorder (ADHD).

METHODS

A comprehensive search of the databases was conducted up to March 3, 2024. We performed a synthesis and meta-analysis of odds ratios and their corresponding 95 % confidence intervals using Stata 14.0. Funnel plot analysis and Egger's regression test were utilized to assess potential publication bias.

RESULTS

Eighteen articles involving 4,289,444 participants were included. AR patients had an increased risk of developing ADHD (OR: 1.83; 95 % CI: 1.37-2.43), while ADHD patients were also more likely to have AR (OR: 1.38; 95 % CI: 1.11-1.72). Subgroup analysis indicated a predisposition of AR patients to autism spectrum disorder (OR: 1.34; 95 % CI: 0.86-1.0) and a higher risk of ADHD in cohort studies (OR: 1.90; 95 % CI: 1.26-2.88). Female AR patients were more likely to develop ADHD than males (OR: 1.86; 95 % CI: 1.43-2.43), and children aged ≤8 years with AR were at greater risk for ADHD compared to older children (OR: 1.75; 95 % CI: 1.14-2.69).

CONCLUSIONS

This meta-analysis confirms a bidirectional association between AR and ADHD, indicating that they are mutually independent risk factors.

Baicalein attenuates ovalbumin-induced allergic rhinitis through the activation of nuclear receptor subfamily 4 group a member 1

Baicalein, one of the major active flavonoids found in Scutellaria baicalensis, has been revealed to exhibit potent anti-inflammatory properties in allergic airway inflammation. This study aimed to explore the role of baicalein and its relevant mechanism in the treatment of allergic rhinitis (AR). The bioinformatics tools were used to predict the targets of baicalein and AR-related genes. AR mice were induced by ovalbumin (OVA) and treated with lentivirus-encapsulated knockdown of nuclear receptor subfamily 4 group A member 1 (NR4A1) or protein arginine N-methyltransferase 1 (PRMT1) plasmids and baicalein. IL-4/IL-13-induced human nasal mucosal epithelial cells (HNEpC) were transfected with knockdown of NR4A1 or PRMT1 plasmids and baicalein treatment. Baicalein alleviated AR-like symptoms and reduced the levels of immunoglobulin E, histamine, and LTC4 in serum and IL-4, IL-25, and IL-33 concentrations in nasal lavage fluids of mice induced with OVA by increasing NR4A1 expression. NR4A1 blocked the NFκB/p65 pathway by mediating transcriptional repression of PRMT1. Knockdown of PRMT1 overturned the effects of NR4A1 knockdown on IL-4/IL-13-induced HNEpC and OVA-induced mice. Collectively, these findings provide evidence that baicalein activation of NR4A1 mediates transcriptional repression of PRMT1 and relieves AR in mice by blocking the NFκB/p65 pathway.

Advancing allergic rhinitis research through phenome-wide association studies: Insights from known genetic loci

Background

Allergic rhinitis (AR) is a common chronic respiratory disease that can lead to the development of various other conditions. Although genetic risk loci associated with AR have been reported, the connections between these loci and AR comorbidities or other diseases remain unclear.

Methods

This study conducted a phenome-wide association study (PheWAS) using known AR risk loci to explore the impact of known AR risk variants on a broad spectrum of phenotypes. Subsequently, linkage disequilibrium score regression (LDSC) and bidirectional two-sample mendelian randomization (TSMR) analyses were used to further analyze the genetic correlation and causal relationships between significant and potentially related phenotypes and AR.

Results

The PheWAS analysis indicated significant associations between asthma, eczema, nasal polyps, hypothyroidism, and AR risk variants. Additionally, potential associations were observed with ulcerative colitis, psoriasis, chalazion, pernicious anemia, glaucoma, multiple sclerosis, arthritis, prostate cancer, varicose veins of lower extremities, and heart attack. LDSC analysis showed that only asthma, eczema, and nasal polyps have significant positive genetic correlations with AR. Furthermore, TSMR analysis revealed causal relationships between AR and asthma, eczema, and nasal polyps.

Conclusion

This study highlights the impact of AR risk loci on a variety of diseases. By revealing new associations and shared genetic pathways, our findings provide valuable insights into the pathophysiology of AR and pave the way for more effective targeted interventions to manage AR and its related diseases.

Deficiency of DEK proto-oncogene alleviates allergic rhinitis by inhibiting RhoA/Ezrin-mediated mitochondrial fission

BACKGROUND

Allergic rhinitis (AR) is a kind of immune disease mediated by IgE. We are intrigued by the potential role of DEK proto-oncogene (DEK) in inflammation-related diseases. We investigated the effects and mechanisms of DEK in treating AR, aiming to identify potential new treatment targets for AR.

METHODS

The AR mouse model was induced by house dust mite (HDM) (1 mg/mL). HNEpCs stimulated by HDM (1 mg/mL) were pretreated for 24 h with or without DEK lentivirus. The effect of DEK knockout or knockdown on AR was evaluated in vitro and in vivo using western blotting, ELISA, flow cytometry, real-time quantitative PCR, immunohistochemistry, HE staining, PAS staining, Diff staining, and immunofluorescence.

RESULTS

After DEK knockdown, the inflammatory response of AR mice was reduced. In addition, DEK deletion mitigated nasal tissue damage and mitochondrial division. Our further studies showed that DEK deletion or inhibition led to the down-regulation of RhoA activity and decreased phosphorylation of Ezrin and Drp1 proteins, and inhibited mitochondrial division. Overall, DEK deficiency mitigated AR by down-regulating RhoA/Ezrin/Drp1 pathway activity.

CONCLUSION

DEK alleviates AR through RhoA/Ezrin/Drp1 signaling pathway, which provides a new perspective for developing improved therapies and understanding the pathogenesis of AR.

Risk and protective factors for coronavirus disease 2019 (COVID-19) in allergic rhinitis patients: a national survey in China

Background

Several epidemiological studies have shown that allergic rhinitis (AR) patients are more susceptible to coronavirus disease 2019 (COVID-19).

Objective

We aim to investigate the risk factors for COVID-19 in AR patients.

Methods

A retrospective nationwide cohort study was conducted based on a questionnaire survey in China. The baseline characteristics, region of residence, smoking and drinking status, comorbidities, vaccination status and previous infection information were obtained. Allergen test results, the SARS-CoV-2 nucleic acid test, and antigen detection results were collected. Information on AR and comorbid medication use pre-SARS-CoV-2 infection was also collected. Binary logistic regression and analysis of covariance (different adjusted models) were conducted.

Results

In all, 830 AR patients were included; 627 patients (75.54%) were infected with SARS-CoV-2. AR comorbid with allergic conjunctivitis (AC) was a protective factor [OR: 0.525 (95% CI = 0.296-0.929), P = 0.027] against SARS-CoV-2 infection, while AR comorbid with food allergy was a risk factor [OR: 6.404 (95% CI = 1.349-30.402), P = 0.0195]. Although fewer patients received four doses of the vaccine, the results showed a significant protective effect against SARS-CoV-2 infection in AR patients [OR: 0.093 (95% CI = 0.025-0.348), P = 0.0004]. Underweight was a protective factor against COVID-19 [OR: 0.287 (95% CI = 0.147-0.562), P = 0.0003] after full multivariable adjustment. Overweight was associated with a 2.071-fold higher risk for COVID-19 compared with normal weight [(95% CI = 1.045-4.105), P = 0.0370]. Additionally, house dust mite (HDM)-specific allergies were also protective against COVID-19 [OR: 0.537 (95% CI = 0.290-0.996), P = 0.0484].

Conclusions

This study revealed underlying protective and risk factors, which might be used to improve the management of AR and COVID-19.

Interleukin 1β Mediates the Pathogenesis of Nasal Mucosal Epithelial Barrier Dysfunction in Allergic Rhinitis

Background

The nasal mucosal epithelial barrier is the primary site of allergic rhinitis (AR). Interleukin-1β (IL-1β), as a crucial factor in immune inflammation, not only plays a crucial role in hypersensitivity reactions but also affects the digestive mucosa and skin epithelial barrier. However, the role of IL-1β in the nasal mucosal epithelial barrier in AR has not been reported, and this study aimed to investigate the effect and possible mechanisms involved.

Methods

Dermatophagoides pteronyssinus 1 was used as an allergen to construct an AR mouse model and stimulate human nasal mucosal epithelial cells (HNEpCs) and observe the expression changes of IL-1β and epithelial barrier indicators CLDN1 and OCLN in mouse nasal mucosa and HNEpCs. Then, the possible mechanisms of action were explored via exogenous IL-1β stimulation and pharmacological inhibition of IL-1β or its receptor interleukin-1 receptor type 1 (IL-1R1).

Results

The results showed that Dermatophagoides pteronyssinus 1-primed mouse nasal mucosa or human HENpCs had increased expression of IL-1β and decreased CLDN1 and OCLN, and IL-1β could directly lead to reduced expression of epithelial barrier indexes in HNEpCs. In addition, inhibition of IL-1β or IL-1R1 can effectively alleviate the damage to the epithelial barrier.

Conclusion

IL-1β has a destructive effect on the nasal mucosal epithelial barrier in AR, and inhibition of IL-1β or its receptor IL-1R1 can effectively protect the nasal mucosal barrier. IL-1β is a potential target for the treatment of AR.

Is intralymphatic immunotherapy effective and safe for allergic rhinitis?: A meta-analysis

BACKGROUND

As there is much controversy in using intralymphatic immunotherapy (ILIT) as a therapeutic means for allergic rhinitis (AR), its efficacy and safety for AR were investigated based on a systematic review and meta-analysis.

METHODS

Databases PubMed, Embase, Cochrane library, and Web of Science were employed to retrieve relevant randomized control studies on ILIT for AR. The search deadline was September 15, 2023. Meta-analysis was performed on the data of the included literature using Stata 15.0.

RESULTS

Eleven randomized control studies were included involving a total of 406 patients. Meta-analysis results revealed that ILIT improved patients' quality of life [standardized mean difference (SMD) = -0.53, 95% confidence interval (CI) = (-1.00, -0.050)], and reduced the adverse events of nasal symptoms [risk ratio (RR) = 0.16, 95% CI = (0.06, 0.45)] as compared to control, whereas no significant difference was discovered in symptom score [SMD = 0.14, 95% CI = (-0.34, 0.62)], IgE [SMD = 0.93, 95% CI = (-0.44, 2.30)], medication scores [SMD = 1.37, 95% CI = (-0.45, 3.18)], comprehensive symptom and medication scores [SMD = 0.93, 95% CI = (-0.62, 2.47)], nasal symptoms [RR = 0.16, 95% CI = (0.06, 0.45)], and lymphadenectasis [RR = 2.27, 95% CI = (0.37, 6.73)] versus control.

CONCLUSION

After the application of the ILIT strategy against AR, the quality of life of patients was improved and the incidence of adverse events associated with nasal symptoms was reduced, but the conclusion needed further verification with more high-quality research.

Impact of the COVID-19 pandemic and lockdown measures on clinical visits and subjective symptoms in childhood allergic rhinitis induced by house dust mites in Shanghai

BACKGROUND

Establishing the interaction between aeroallergens and air pollution in children with house dust mite induced allergic rhinitis (HDM-AR) remains challenging, especially in urban areas. The coronavirus disease 2019 (COVID-19) pandemic and the subsequent lockdown measures provided a valuable opportunity.

METHODS

We analyzed the clinical data of HDM-AR children between March and August in 2018-2020, and classified the children according to the type and the degree of HDM sensitization. The records of patients' hospital visits, allergic rhinitis symptoms assessments, and air pollution measurements in Shanghai were used to assess the differences before (2018-2019) and during the pandemic (2020), as well as during lockdown (March-June) and unlockdown (July-August) period in 2020.

RESULTS

The study included 1570 HDM-AR children aged 2 to 8 years old, 815 (51.9%) were monosensitized to HDM (mono-HDM-AR), and 755 (48.1%) were polysensitized to HDM (poly-HDM-AR). There was a significant increase in the rate of clinical visits among children with HDM-AR during the COVID-19 pandemic compared to pre-pandemic (P < 0.001), particularly among older children aged 7-8 years (P = 0.01). During the unlockdown period, there was a notable decrease in clinical visits for children with poly-HDM-AR (P < 0.001). Children with high levels of HDM sensitization exhibited significant symptom improvement in unlockdown period (P < 0.001). Although the air pollutants concentration had improved during the study, there was no effect on the improvement of HDM-AR children as expected.

CONCLUSIONS

The COVID-19 pandemic and its associated lockdown measures provided a unique context to observe the dynamics of management in children with HDM-AR. The findings underscore the complexity of managing allergic conditions in pediatric populations, highlighting the influence of environmental and lifestyle changes on disease presentation and the need for tailored approaches to treatment during periods of societal disruption.

Association Between Frequency of Away-From-Home Meals and Prevalence of Inflammatory Sinonasal Diseases: A Population-Based Cross-Sectional Study

At the beginning of the COVID-19 pandemic, people had to stay at home due to quarantine, and the food delivery industry grew significantly. Concerns have been raised regarding the popularity of away-from-home (AFH) meals and their impact on health. In this study, we evaluated the association between the frequency of AFH meals and the prevalence of allergic rhinitis (AR) and chronic rhinosinusitis (CRS). In this cross-sectional study, the Korean National Health and Nutrition Examination Survey was reviewed from 2010 to 2019. The frequency of AFH meals was assessed as how often the respondents ate AFH meals in an average week. Those who ate AFH meals less than once per week were designated as group 1, one to four times as group 2, and five times or more as group 3. The diagnoses of AR and CRS were evaluated, and symptoms, endoscopic findings, and serum immunoglobulin E (IgE) levels were assessed. Logistic regression analyses were performed. A total of 48,515 participants were eligible. In multivariate logistic regression analysis for AR, when compared to group 1, the odds ratios (ORs) for AR in participants of group 2 (OR = 1.226, 95% confidence interval [CI] = 1.136-1.324) and group 3 (OR = 1.227, 95% CI = 1.126-1.337) were significantly higher (p < 0.0001). For CRS, group 2 (OR = 1.139, 95% CI = 1.029-1.260) and group 3 (OR = 1.210, 95% CI = 1.078-1.358) showed a significantly higher risk than group 1 (p = 0.0044). Individuals who consume AFH meals frequently might suffer less from AR or CRS if they change their dietary habits and prepare meals more often at home.

Trans-resveratrol mitigates miR-204-3p mediated progression of allergic rhinitis by regulating the EGLN3/HIF-1α/IL33/ST2 signalling pathway

BACKGROUND

Allergic rhinitis (AR) is a multifactorial disease triggered by interactions between genes and the environment. Clinical evidence has shown that trans-resveratrol, a widely used drug, significantly ameliorates AR pathology. However, the precise mechanisms underlying this effect remain unclear.

PURPOSE

This study aimed to elucidate the pharmacological mechanisms of action of trans-resveratrol in patients with AR who exhibit hypoxic symptoms. This will be achieved through microRNA sequencing and signaling pathway screening combined with basic experiments to determine the effects of Trans-resveratrol intervention in this patient population.

METHODS

Network pharmacology was used to determine the therapeutic value of trans-resveratrol in AR. The micro-RNA miR-204-3p was pinpointed by sequencing. Quantitative reverse transcription polymerase chain reaction was used to quantify the expression levels. Haematoxylin and eosin, alcian blue-periodic acid-Schiff, and Masson's trichrome staining were used to assess the effects of hypoxia on nasal mucosa immunohistochemistry and immunofluorescence-localised target proteins. Egl nine homolog 3 (EGLN3) was screened using bioinformatics software. Protein expression was detected by western blotting. Cell growth and death were gauged via Cell Counting Kit-8 and terminal deoxynucleotidyl transferase dUTP nick end labelling staining, respectively. Cell migration was observed using a transwell assay. Enzyme-linked immunosorbent assay was used to measure interleukin (IL)33 levels in the cell supernatants. Flow cytometry was used to verify cell cycle and antigen levels. Electron microscopy was used to visualise the status of the nasal mucosa prior to in vivo expression analysis.

RESULTS

Patients with hypoxic AR demonstrated more pronounced nasal mucosal remodelling than that in patients with common AR. Sequencing results indicated that these patients had a reduced expression of miR-204-3p. Through a combination utilizing of bioinformatics analysis and experimental validation, EGLN3 has been identified as a direct target of HIF-1α. The low expression level of miR-204-3p represses EGLN3, resulting in the accumulation of HIF-1α and the activation of the IL33/ST2 signaling pathway. These stimulate the proliferation, survival, and migration of HNEpCs, ultimately contributing to mucosa remodeling and AR progression. Trans-resveratrol notably downregulated the levels of HIF-1α and IL33/ST2, while simultaneously increasing the expression of EGLN3.

CONCLUSIONS

Downregulation of miR-204-3p initiated a vicious cycle of hypoxic AR via EGLN3/HIF-1α/IL33/ST2. Trans-resveratrol reversed the pathological process of nasal mucosa remodeling of hypoxic AR by exhibiting anti-inflammatory and anti-angiogenic functions via the above signaling pathway. Our study uncovers the underlying mechanism by which hypoxia drives the progression of AR. It presents innovative strategies for addressing inflammatory and hypoxia-related diseases, bridging traditional and modern medicine, and highlighting the potential of natural compounds in clinical practice.

Multi-omic integration reveals alterations in nasal mucosal biology that mediate air pollutant effects on allergic rhinitis

BACKGROUND

Allergic rhinitis is a common inflammatory condition of the nasal mucosa that imposes a considerable health burden. Air pollution has been observed to increase the risk of developing allergic rhinitis. We addressed the hypotheses that early life exposure to air toxics is associated with developing allergic rhinitis, and that these effects are mediated by DNA methylation and gene expression in the nasal mucosa.

METHODS

In a case-control cohort of 505 participants, we geocoded participants' early life exposure to air toxics using data from the US Environmental Protection Agency, assessed physician diagnosis of allergic rhinitis by questionnaire, and collected nasal brushings for whole-genome DNA methylation and transcriptome profiling. We then performed a series of analyses including differential expression, Mendelian randomization, and causal mediation analyses to characterize relationships between early life air toxics, nasal DNA methylation, nasal gene expression, and allergic rhinitis.

RESULTS

Among the 505 participants, 275 had allergic rhinitis. The mean age of the participants was 16.4 years (standard deviation = 9.5 years). Early life exposure to air toxics such as acrylic acid, phosphine, antimony compounds, and benzyl chloride was associated with developing allergic rhinitis. These air toxics exerted their effects by altering the nasal DNA methylation and nasal gene expression levels of genes involved in respiratory ciliary function, mast cell activation, pro-inflammatory TGF-β1 signaling, and the regulation of myeloid immune cell function.

CONCLUSIONS

Our results expand the range of air pollutants implicated in allergic rhinitis and shed light on their underlying biological mechanisms in nasal mucosa.

Depression of CaV1.2 activation and expression in mast cells ameliorates allergic inflammation diseases

Allergic inflammation is closely related to the activation of mast cells (MCs), which is regulated by its intracellular Ca2+ level, but the intake and effects of the intracellular Ca2+ remain unclear. The Ca2+ influx is controlled by members of Ca2+ channels, among which calcium voltage-gated channel subunit alpha1 C (CaV1.2) is the most robust. This study aimed to reveal the role and underlying mechanism of MC CaV1.2 in allergic inflammation. We found that CaV1.2 participated in MC activation and allergic inflammation. Nimodipine (Nim), as a strong CaV1.2-specific antagonist, ameliorated allergic inflammation in mice. Further, CaV1.2 activation in MC was triggered by phosphatizing at its Ser1928 through protein kinase C (PKC), which calcium/calmodulin-dependent protein kinase II (CaMKII) catalyzed. Overexpression or knockdown of MC CaV1.2 influenced MC activation. Importantly, CaV1.2 expression in MC had detrimental effects, while its deficiency ameliorated allergic pulmonary inflammation. Results provide novel insights into CaV1.2 function and a potential drug target for controlling allergic inflammation.

Guaijaverin And Epigallocatechin Gallate Exerts Antiinflammatory And Antiallergenic Effects Through Interleukin-12 Production

Our aim in the current study was to determine the in vitro and in vivo synergistic antiinflammatory and antiallergic effect associated with the IL-12 production of guaijaverin and epigallocatechin gallate (EGCG) complex (GEC) and ILS-F-2301 (2:8 extract of Psidium guajava and Camellia sinensis). Compared to EGCG alone, GEC showed synergistic inhibition of nitric oxide (NO), inducible NO synthase, and cyclooxygenase-2 by 3.8, 5.1, and 4.1%, respectively. The downregulation of interleukin-12 (IL-12) by 2,4-dinitrophenyl-human serum albumin conjugate/DNP-immunoglobulin E or ovalbumin (OVA) was synergistically increased by GEC by about 7.5% or 5.4% compared to EGCG alone. The level of downregulation of IL-12 in plasma increased by 100 mg/kg with ILS-F-2301 (28.7%) when compared to the OVA/Alu-treated group. Also, GEC synergistically increased by GEC by about 7.5% or 5.4% compared to EGCG alone. The level of down and cyclooxygenase C synergistically inhibited p-Akt, PI3K, mTOR, p-STAT6, and GATA3 by 4.9%, 4.1%, 19.2%, 23.8%, and 35.3%, respectively, while increasing the expressions of p-STAT1 and T-bet (showing 53.3% and 9.4% activation) when compared to EGCG alone. In an allergenic rhinitis mouse model, 100 mg/kg of ILS-F-2301 was shown to inhibit p-Akt, PI3K, mTOR, p-c-Jun N-terminal kinase (p-JNK), p-extracellular signal-regulated kinase (p-ERK), and p-p38 by 23.3%, 43.8%, 17.2%, 32.2%, 29.1%, and 41.8% when compared to the OVA/Alu-sensitized group. Taken together, our findings suggest that ILS-F-2301 may have potential as a functional food for alleviating antiallergic rhinitis.

Analysis of criteria for choosing drug treatment strategies in allergic rhinitis

Background

Allergic rhinitis (AR) is the most common type of rhinitis, the treatment of which relies on relieving symptoms. Therefore, we aimed to assess the criteria that influence doctors' decision-making in the process of drug selection for the treatment of allergic rhinitis based on quantitative, qualitative, and cost analyses.

Methods

We conducted a survey study with the participation of 300 allergologists. A self-developed questionnaire was presented during a computer-assisted telephone interview (CATI) according tostandard procedures. The contingency table underwent statistical analysis using the chi-square test with Cramer's V. Results were considered statistically significant at p < 0.05.

Results

Our analyses showed that doctors most often prescribe intranasal glucocorticoids and oral antihistamines to treat allergic rhinitis in patients of all ages. The most common factor that affects the decision-making related to AR treatment was the efficiency of the drug. We found a significant relationship between factors and the main workplace (X-squared = 122.81, df = 90, p-value = 0.0123, Cramer's V = 0.1787216), as well as voivodeship of the main workplace (X-squared = 440.75, df = 270, p-value = 2.378e-10, Cramer's V = 0.1954731). In our study, respondents claimed that patients are willing to pay 31-50 PLN (∼€7- €11) monthly for the treatment of mild and moderate forms of AR, while they were willing to pay 51-100 PLN (∼€11-€22) for treatment of the severe AR form.

Conclusion

Our study confirms that the management of AR should be focused on the patient. One of the most important factors in choosing a drug is its effectiveness. Moreover, an important factor in the effective treatment of AR is the financial issue; as shown in our analysis, AR treatment costs can be a significant burden, especially for less wealthy citizens in Poland.

BPIFA1 alleviates allergic rhinitis by regulating the NF-κB signaling pathway and Treg/Th17 balance

AIM

Allergic rhinitis (AR) is an allergic condition characterized by inflammation of the nasal mucosa. Bacterial permeability-increasing family member A1 (BPIFA1) exhibits anti-inflammatory properties; however, its impact on AR remains unclear. Aim of this study is to investigate the expression and function of BPIFA1 in AR and its influence on inflammation and immune regulation in a mouse model of AR induced by ovalbumin (OVA).

METHODS

The expression of BPIFA1 was analyzed using quantitative real-time PCR (qRT-PCR) and immunohistochemistry (IHC). Morphological assessments of nasal mucosal tissues were conducted. Levels of inflammatory mediators in nasal lavage fluid (NALF) and serum were quantified using enzyme-linked immunosorbent assay (ELISA) kits. Protein expressions of BPIFA1, phosphorylated and total p65 (p-p65/p65), and IκBα were evaluated through Western blot analysis. The total cell counts, including epithelial cells, eosinophils, and lymphocytes in NALF, were determined using a hemocytometer. A mouse model of AR was established by OVA management.

RESULTS

BPIFA1 expression was found to be reduced in the nasal mucosa tissues of patients with AR, suggesting a potential role in the disease's progression. We successfully developed a mouse model of AR, where BPIFA1 was similarly downregulated, indicating its possible involvement in modulating the NF-κB signaling pathway. Overexpression of BPIFA1 in this model attenuated inflammation and allergic responses by inhibiting the NF-κB pathway. Additionally, overexpression of BPIFA1 promoted the differentiation of regulatory T cells (Treg) and inhibited the differentiation of T helper 17 cells (Th17) in the NALF of AR mice, further demonstrating its regulatory impact on immune responses. The study confirmed that BPIFA1 upregulation reduced the levels of inflammatory cytokines TNF-α and IL-6, decreased infiltration of inflammatory cells, and modulated antigen-specific immunoglobulin levels and histamine in serum.

CONCLUSION

BPIFA1 mitigated both inflammatory and allergic responses in AR mice induced by OVA through the modulation of the NF-κB signaling pathway and the balance between regulatory T cells (Treg) and T helper 17 cells (Th17). These findings suggest that BPIFA1 could serve as a novel biomarker and therapeutic target for AR, offering potential for the development of targeted treatments to improve patient outcomes.

Causal relationship between allergic rhinitis and otitis media: A Mendelian randomization study

Otitis media and allergic rhinitis are prevalent conditions. Some data posit a significant association between the 2 ailments, proposing mechanisms such as allergic rhinitis-induced Eustachian tube dysfunction or concurrent allergic pathophysiology affecting both the nasal and aural cavities. Observational studies hint at an association between allergic rhinitis (AR) and nonsuppurative otitis media, yet definitive causality remains elusive. Thus, to elucidate the causal impact of AR on otitis media, a 2-sample Mendelian randomization study was undertaken. Data on AR, acute suppurative otitis media, chronic suppurative otitis media, and nonsuppurative otitis media were sourced from the Genome for Extensive Association Study, encompassing individuals of European ancestry. Single nucleotide polymorphisms linked with AR were utilized as instrumental variables. The inverse-variance weighting (IVW) method, alongside sensitivity analyses employing the weighted median and Mendelian randomization-Egger methods, was employed to assess causal effects. Our analysis revealed a significant causal effect of AR on nonsuppurative otitis media (IVW, odds ratio [OR] = 12.22, 95% confidence interval, 1.38-107.93, P = .024) and indicated an association with acute suppurative otitis media (IVW, OR = 6.95, 95% confidence interval, 0.80-60.35, P = .078). However, no causal effect of AR on chronic suppurative otitis media was discerned. Our findings delineate a measurable causal link between AR and nonsuppurative otitis media (OR = 12.22) and suggest an association with acute suppurative otitis media (OR = 6.95), though lacking evidence for a causal effect on chronic suppurative otitis media. These results underscore the propensity of AR to correlate with diverse forms of otitis media and furnish high-quality causal evidence pertinent to clinical management.

The NLRP3 inflammasome in allergic diseases: mechanisms and therapeutic implications

In recent years, there has been a global increase in the prevalence of allergic diseases, including allergic rhinitis, chronic rhinosinusitis, allergic asthma, atopic dermatitis, allergic conjunctivitis, and food allergies. Since the pathogenic mechanisms of these allergic diseases are not yet fully understood, targeted and effective therapies are lacking. The NLRP3 inflammasome, a multiprotein complex implicated in various inflammatory diseases, can be activated by diverse stimuli. It assembles into NLRP3 inflammasome complexes through conformational changes, initiating the proteolytic cleavage of dormant procaspase-1 into active caspase-1 and promoting the maturation of inflammatory cytokines, including IL-1β and IL-18. Dysfunction of the NLRP3 inflammasome may serve as a key driver of inflammatory diseases, leading to pyroptosis and amplifying the local inflammatory response. As preliminarily demonstrated, specific NLRP3 inflammatory vesicle inhibitors play refectory roles in animal models of allergic diseases, and it is believed that specific NLRP3 inflammasome inhibitors may be potential therapeutic agents for allergic diseases. This review highlights the progress of research on the NLRP3 inflammasome in allergic diseases, explores its contribution to different types of allergic diseases, and identifies promising clinical targets for intervention.

Trends and research foci in immunoregulatory mechanisms of allergic rhinitis: a bibliometric analysis (2014-2024)

Background

This study aims to provide a comprehensive bibliometric analysis of research trends, hotspots, and future directions in the immunoregulatory mechanisms of allergic rhinitis (AR) from 2014 to 2024.

Methods

Data were sourced from the Web of Science Core Collection (WoSCC), covering articles and reviews published between April 1, 2014, and March 31, 2024. The search terms included "Allergic Rhinitis," "AR," and related terms along with specific keywords related to immune cells and inflammatory mediators. Bibliometric tools such as CiteSpace, VOSviewer, and SCImago Graphica were used to analyze institutional cooperation networks, keyword co-occurrence, citation bursts, and research topic evolution. Microsoft Excel 2019 was employed to display annual publication trends.

Results

A total of 2200 papers met the inclusion and exclusion criteria. The number of publications showed an upward trend over the past decade, with a significant peak in 2021. China (583 papers) and the United States (454 papers) were the major contributing countries. Imperial College London emerged as the leading institution. Key research frontiers identified include the roles of NF kappa B and air pollution in AR. Keyword burst analysis revealed emerging topics such as respiratory allergy and personalized treatment strategies. Notable limitations include the exclusive use of the WoSCC database and the restriction to English-language publications.

Conclusion

The field of immunoregulatory mechanisms in allergic rhinitis has seen significant growth, with China and the United States leading the research. Future research should focus on developing personalized treatment plans and understanding the comprehensive impact of environmental factors. Continued interdisciplinary collaboration and international cooperation will be essential for advancing therapeutic strategies in AR.

New insights into allergic rhinitis treatment: MSC nanovesicles targeting dendritic cells

Allergic rhinitis (AR) is a condition with limited treatment options. This study investigates the potential use of mesenchymal stem cell (MSC) nanovesicles as a novel therapy for AR. Specifically, the study explores the underlying mechanisms of MSC nanovesicle therapy by targeting dendritic cells (DCs). The researchers fabricated DC-targeted P-D2-EVs nanovesicles and characterized their properties. Transcriptomic sequencing and single-cell sequencing analyses were performed to study the impact of P-D2-EVs on AR mice, identifying core genes involved in the treatment. In vitro cell experiments were conducted to validate the effects of P-D2-EVs on DC metabolism, Th2 differentiation, and ILC2 activation. The results showed that P-D2-EVs efficiently targeted DCs. Transcriptomic sequencing analysis revealed differential expression of 948 genes in nasal tissue DCs of mice treated with P-D2-EVs. Single-cell sequencing further revealed that P-D2-EVs had inhibitory effects on DC activation, Th2 differentiation, and ILC2 activation, with Fut1 identified as the core gene. Validation experiments demonstrated that P-D2-EVs improved IL10 metabolism in DCs by downregulating Fut1 expression, thereby suppressing Th2 differentiation and ILC2 activation. Animal experiments confirmed the inhibitory effects of P-D2-EVs and their ability to ameliorate AR symptoms in mice. The study suggests that P-D2-EVs reshape DC metabolism and suppress Th2 differentiation and ILC2 activation through the inhibition of the Fut1/ICAM1/P38 MAPK signaling pathway, providing a potential therapeutic approach for AR.

New progress in pediatric allergic rhinitis

The prevalence of allergic rhinitis (AR) in children is steadily increasing, and its onset is closely associated with genetic factors, living environment, and exposure to allergens. In recent years, an increasing number of diagnostic methods have been employed to assist in diagnosing AR. In addition to pharmaceutical treatments, personalized approaches such as environmental control and allergen-specific immunotherapy are gradually gaining popularity. In this article, we reviewed recent research on the etiology, diagnostic classification, treatment methods, and health management of AR in children. These insights will benefit the implementation of personalized diagnosis and treatment for children with AR, promoting health management strategies that improve symptoms and quality of life.

Evaluation of the Correlation Between Nasal Secretion ECP-MPO Test Papers and Immune Markers in Subcutaneous Immunotherapy of Dust Mites

Purpose

Up to now, there is no generally accepted biomarker to indicate the clinical response of immunotherapy. This study mainly analyzed the correlation between eosinophil cationic protein-myeloperoxidase (ECP-MPO) test papers and other immunotherapy indices in subcutaneous immunotherapy of dust mites and to explore whether the test paper can be used as an auxiliary index to quickly evaluate the efficacy of immunotherapy.

Patients and methods

This study included 53 participants who received subcutaneous immunotherapy at the allergy clinic of Renmin Hospital of Wuhan University and 28 control participants. Six visits were conducted during a prospective study over one year. The results of the ECP-MPO test paper, nasal secretion eosinophil smear and count, nasal secretion ECP concentration, and clinical symptom scores were collected during five follow-up visits after the start of subcutaneous immunotherapy. Th1/Th2/Th17 cytokines, chemokines, IgE, IgG4 against dust mite components, and ECP concentrations were detected in the serum of participants at baseline, six months, and one year after subcutaneous immunotherapy.

Results

The ECP test paper is not only easy to operate, but also can effectively and quickly detect the concentrations of ECP in the nasal secretion and diagnose allergic rhinitis. Symptom score is an important index for evaluating clinical immune efficacy, during subcutaneous immunotherapy, the ECP test paper showed a positive correlation with the symptom score. Simultaneously, during immunotherapy, the changes in the chromogenic grading of the test paper were synchronized with the changes in inflammatory cytokines and eosinophilic chemokines in Th2 cells of serum dust mite IgE. The sIgG4 against dust mites weakly negatively correlated with the concentration of ECP in nasal secretions and the color classification of the ECP test paper.

Conclusion

The ECP-MPO test paper has a certain correlation with subcutaneous immunotherapy markers of allergic rhinitis, indicating that the ECP test paper may become an auxiliary biomarker to replace other complex laboratory tests.

Analysis of IgE level influencing factors of common allergens for allergic rhinitis in northeastern China

OBJECTIVES

This thesis aims to provide patients with a preventive and therapeutic basis by analyzing IgE level influencing factors of common allergens for Allergic Rhinitis (AR).

METHOD

Multiple linear regression analysis is made upon questionnaires among 749 cases of AR patients that are divided into 5 age-based groups. Perform serum-specific IgE content testing on patients.

RESULTS

Cockroach being an allergen, AR patients' IgE Level is influenced by allergic history, home-raised plants and animals. For AR patients with mugwort as an allergen, allergy and asthma history could increase IgE level, respectively, β = 4.291 and β = 4.364. If the allergen turns out to be peanut, allergic history would increase the IgE level (β = 0.171), however, the level would be lower in female patients compared with male patients (β = -0.078). For patients with egg as an allergen, allergic history, home-raised plants and animals (pets) would all affect the IgE level, respectively, β = 0.182, β = 0.118 and β = -0.101.

CONCLUSIONS

IgE level varies according to allergic history, home-raised plants & animals, gender, furniture renewal, asthma, and ages for patients with different allergens including cockroach, mold, mugwort, peanut, egg and crab. For each kind of allergen, the IgE levels react differently to different influencing factors, thus requiring a thorough analysis of each AR patient's allergen and allergenic factors.

Recent Advances in Allergic Rhinitis: A Narrative Review

Allergic rhinitis (AR) is a prevalent chronic respiratory condition characterized by nasal inflammation, sneezing, congestion, and itching, significantly impacting quality of life. Over recent years, considerable advancements have been made in understanding the pathophysiology, diagnosis, and management of AR. This narrative review aims to synthesize these recent developments, providing a comprehensive overview of key areas. Emerging insights into AR pathophysiology have elucidated the complex interplay between genetic predisposition, environmental factors, and immune system dysregulation. Notably, the role of the epithelial barrier and the microbiome in AR pathogenesis has garnered increasing attention, offering potential targets for novel therapies. Advances in diagnostic technologies, such as component-resolved diagnostics and molecular allergology, have enhanced the precision of allergy identification, enabling more personalized treatment approaches. In terms of management, significant progress has been made in pharmacological and non-pharmacological treatments. Novel biologics targeting specific pathways involved in AR, including monoclonal antibodies against immunoglobulin (Ig)E and interleukin (IL)-4/13, have shown promise in reducing symptoms in refractory cases. Additionally, there has been a resurgence in interest in non-pharmacological strategies, including allergen avoidance, immunotherapy, and complementary therapies, which offer holistic options for patient care. The integration of digital health tools and mobile applications in AR management has further empowered patients, allowing for real-time symptom tracking and personalized treatment adjustments. Recent guidelines emphasize a multidisciplinary approach to AR management, promoting integrated care models that involve collaboration between allergists, primary care providers, and other specialists. These guidelines also highlight the importance of patient-centered care, advocating for shared decision-making and tailored treatment plans based on individual patient profiles. In conclusion, the landscape of allergic rhinitis management is rapidly evolving, with ongoing research and innovation paving the way for improved outcomes. This review underscores the importance of staying abreast of these advances to optimize the care and quality of life for individuals affected by allergic rhinitis.

Guaijaverin and Epigallocatechin Gallate Complex Modulate Th1 and Th2 Cytokine-Mediated Allergic Responses Through STAT1/T-bet and STAT6/GATA3 Pathways

We aimed to determine the in vitro and in vivo synergistic antiallergic effect of guaijaverin and epigallocatechin gallate (EGCG) complex (GEC), and the antiallergic rhinitis (AR) properties of guaijaverin-rich Psidium guajava and EGCG-rich Camellia sinensis (ILS-F-2301). GEC showed synergistic inhibition of β-hexosaminidase by 4.20% and interleukin (IL)-4, -5, and -13 by 4.08%, 0.67%, and 4.71%, respectively, while increasing interferon (IFN)-γ by 12.43%, compared with EGCG only. In addition, 50 μg/mL of ILS-F-2301 inhibited β-hexosaminidase release, and inhibited IL-4, -5, and -13 by 61.54%, 58.79%, and 59.25%, respectively, while increasing IFN-γ (showing 133.14% activation). Moreover, 50 μg/mL of ILS-F-2301 suppressed p-STAT6 and GATA3, while p-STAT1 and T-bet increased, and 0.039 μg/mL of guaijaverin or 5.275 μg/mL of EGCG modulated T helper (Th)1- and Th2-related proteins. These data suggested that guaijaverin and EGCG in ILS-F-2301 was the main active compound involved in Th1/Th2 modulation. In the AR mouse model, the administration of ILS-F-2301 inhibited ovalbumin (OVA)-specific IgE, histamine in serum; it also inhibited IL-4 and -5 by 28.23% and 47.15%, respectively, while increasing IFN-γ (showing 37.11% activation), compared with OVA/Alu-treated mice. Taken together, our findings suggest that ILS-F-2301 is a functional food for alleviating anti-AR.